[Managing psychogeriatric patients who stopped eating]

We carried out a small survey among 22 interviewees working as physicians (n = 11) or as nurses (n = 11) in a nursing home. The questions concerned the last case they had seen of a psychogeriatric patient who did not eat any more, and the decision-making process. 35 patients were described to us: 13 in whom feeding was continued (mostly by drip) and 22 in which it was withheld. It appeared that the withholding of artificial feeding was the more common decision. If feeding was continued it was usually a time-limited trial. The decision-making process appeared to be careful and elaborate. Among the reasons to withhold feeding was the thought that the patient did not wish to live any more and was showing this by refusing to eat. Formal criteria for determining mental (in)competence were not used, however. When patients died after discontinuation of feeding, the dying process mostly was peaceful (15/17); five of the 22 patients in whom feeding was discontinued spontaneously resumed eating.